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DMST ABD 3 > Metabolic Disease: GB And Bile Ducts > Flashcards

Metabolic Disease: GB And Bile Ducts Flashcards

(51 cards)

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1
Q

What is biliary sludge? 2

A
  1. Biliary sand/ Microlithiasis
  2. A mixture of particulate matter and bile
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2
Q

Biliary sludge can be a precursor of what?

A

GB disease

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3
Q

Are there s/s with Biliary sludge? Does it resolve?

A
  1. May or may not have symptoms
  2. May resolve by spontaneously
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4
Q

Bile stasis most likely cause is what? 4

A
  1. Prolonged fasting
  2. Rapid weight loss
  3. TPN
  4. Extrahepatic biliary obstruction
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5
Q

What does bile look like sonographically? 4

A
  1. Non- shadowing homogenous low level echoes
  2. Layers in dependent part of GB
  3. Fluid/ fluid level
  4. Moves with changing position of patient
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6
Q

Sludge ball/ tumefactive sludge is what? (what does it mimic?)

A

Sludge that mimics polyploid tumors

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7
Q

How do we differentiate sludge balls and polyp? 3

A
  1. Look at vascularity
  2. Mobility (polyploid are not mobile)
  3. GB wall thickness (Sludge might not have thickened wall)
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8
Q

What is GB hepatization? What does it do?

A
  1. When sludge has the same echogenicity as the liver
  2. Camouflages the GB
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9
Q

What is pseudo sludge? 3

A

Artifacts due to
1. Excessive gains
2. Slice thickness or side lobe artifacts
3. Independent of gravity

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10
Q

What is Empyema?

A

The presence of pus in the bile

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11
Q

What is Hemobilia?

A

The presence of blood in bile, usually due to liver biopsy, Percutaneous biliary procedures

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12
Q

How common is Milk of calcium (limey bile)?

A

Rare

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13
Q

Milk of calcium is a different category of what?

A

Biliary sludge

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14
Q

What is milk of calcium (limey bile) ?

A

GF filled with semi solid deposit

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15
Q

How does Milk of calcium (Limey bile) look like sonographically? 4

A
  1. Hyperechoic debris
  2. Posterior shadowing
  3. Changes with position
  4. Calcium/ bile fluid level
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16
Q

What is a cholelithiasis?

A

Gallstones

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17
Q

What is the most common condition of the GB?

A

Gallstones/ Cholelithiasis

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18
Q

What is the etiology of Gallstones? 3

A
  1. Abnormal bile composition
  2. Biliary stasis
  3. Infection
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19
Q

What is the patient clinical presentation of gallstones? 4 (s/s)

A
  1. Asymptomatic
  2. RUQ pain (after meals)
  3. N and V
  4. Belching
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20
Q

Who is at risk for gallstones?5

A
  1. Female
  2. Fat
  3. Fertile
  4. Forty
  5. Family history
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21
Q

Gallstones need to be at least how big to shadow

Study These Flashcards
A

1mm but <5mm may not shadow

22
Q

What is the sonographic appearance of gallstones? 4

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A
  1. Echogenic focus
  2. Posterior shadowing
  3. Mobile
  4. Float in bile
23
Q

What are some things that might cause some false positives for gallstones? 3

Study These Flashcards
A
  1. Valves of heisted
  2. Fat in porta hepatis
  3. Duodenal gas
24
Q

WES sign is seen when?

Study These Flashcards
A

The GB is filled with multiple stones or one large stone

25
What are some lab values that are affected by Gallstone? 4
1. AST 2. ALT 3. ALP 4. BILI
26
What are some complications of Gallstones? 5
1. **Biliary colic** 2. Obstruction of cystic duct or CBD > hydrops 3. Bacterial infection 4. Cholecystits 5. Ascending cholangitis
27
What is the most common complication of gallstones
Biliary colic
28
An ultrasound examination to investigate possible obstruction of the biliary tree should focus on answering what three questions?
1. Are the bile ducts or GB dilated 2. If yes, to what level 3. If yes, what is the cause
29
What kind of dilation can the biliary tract be? 2
Biliary dilation may be 1. Intra or extra hepatic 2. Mild, moderate, or severe
30
What causes the ducts to dilate? 3
1. Obstruction 2. Loss of duct wall elasticity 3. Ampullary dysfunction
31
What is the clinical presentation of biliary obstruction? 2 (s/s)
Painless or painful jaundice
32
How does painless biliary obstruction clinically present like? 2 (not s/s)
1. Neoplastic conditions 2. Choledochal cysts
33
What is the clinical presentation of painful jaundice of biliary obstruction seen with?
Seen with acute obstruction (stones) and/or infection of the biliary tree
34
What are S/S of obstruction? 4
1. Jaundice 2. Clay covered stools 3. Abnormal LFT 4. Pain, nausea
35
What is Choledocholithiasis?
Stones in the biliary tree
36
What are secondary causes of choledocholithiasis?
Most commonly stones passing from GB to ducts
37
What are some primary causes of choledocholithiasis? 2
1. Formation of stones in the duct 2. Related to inflammation, certain types of infection, caroli disease, prior surgery
38
What is the most common location of choledocholithiasis?
Distal CBD at ampulla of vater
39
What does choledocholithiasis looks like sonographically? 2
1. Hyperechoic focus 2. Posterior shadowing
40
What are some scanning techniques for scanning choledocholithiasis? 4
1. Change patient position 2. Compress bowel 3. Change windows 4. Use pancreatic head for reference
41
What would result in false positives of choledocholithiasis? 3
1. Surgical clips post cholecystectomy 2. Air 3. Edge artifact
42
What are some lab values that are affected by choledocholithiasis? 4
Increase in 1. ALP 2. AST 3. ALT 4. Bilirubin
43
What are treatment options for choledocholithiasis? 3
1. ERCP spincterotomy 2. ERCP extraction 3. Stenting
44
What does this image demonstrate?
Biliary sludge
45
What does this image represent?
Sludge balls/ tumerfactive sludge
46
What does this image represent?
GB hepatization
47
What does this image represent?
Cholelithiasis
48
What does this image represent?
Gall stones
49
What does this image represent?
WES sign (Wall, Echo, shadow)
50
What does this image represent?
Choldedocholithiasis
51
What does ERCP stand for?
Endoscopic retrograde cholangiopancreatograph

DMST ABD 3 (11 decks)

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